Take-home: In chronic central retinal vein occlusions, aflibercept (Eylea, Regeneron Pharmaceuticals) showed to increase the cystoid macular edema-free interval.
Cystoid macular edema (CME) might become less problematic in patients with non-ischemic central retinal vein occlusions (CRVOs).
The 1-year results released from the NEWTON Study (Intravitreal AflibErcept Injection of previously treated Macular Edema Associated With Central ReTinal Vein Occlusion) indicated that intravitreal aflibercept injections (Eylea, Regeneron Pharmaceuticals) staved off recurrences of CME for a longer period in patients who had been treated with anti-vascular endothelial growth factor (anti-VEGF) drugs.
“Even though anti-VEGF therapy is effective for treating CME associated with CRVOs, the treatment is chronic and the treatment interval with ranibizumab (Lucentis, Genentech) and bevacizumab (Avastin, Genentech) is limited,” according to Rahul Khurana, MD, who is in private practice in Mountain View, CA.
CRVOs have received a lot of attention over the last 20 years with limited success until 2009 with the introduction of intravitreal corticosteroids and anti-VEGF injections.
“Anti-VEGF treatments are extremely effective for CME secondary to CRVOs,” Dr. Khurana explained. “However, in the pivotal phase III clinical trials, the primary endpoint was only at 6 months, compared to 2 years with diabetic macular edema and neovascular age-related macular degeneration; and it begs the question, “Is macular edema associated with CRVOs really a 6-month disease?”
Long-term outcomes of patients treated with ranibizumab show that it is indeed a chronic disease in many patients requiring frequent injections. Dr. Khurana recounted that the RETAIN Study by Peter Campochiaro, MD, of the Wilmer Eye Institute/Johns Hopkins University and colleagues who looked at 32 patients with CRVOs from the original CRUISE Study. These patients were followed for 4 years after treatment, and 56% required frequent injections at the rate of every 8 weeks and they had reduced visual potential (Ophthalmology 2014; 121: 209-219).
Along with considerations of the available therapies, questions about dosing strategies also arose, with consideration given to monthly, as-needed, and treat-and-extend options, Dr. Khurana said.
In the 2015 American Society of Retina Specialists Preferences and Trends Survey, Dr. Khurana pointed out that the treat-and-extend regimen was favored by 56% of retina specialists, in contrast to 40% who opted for as-needed treatment, and 1% who still hung on to a monthly dosing strategy.